Hassan Galadari

Newly available treatments for psoriatic arthritis and their impact on skin psoriasis.

Far from being a “benign” arthropathy, as it was initially characterized, psoriatic arthritis (PsA) affects approximately 0.2% of the US population and can be associated with considerable joint damage, symptomatology, and quality of life impairment. PsA shares many characteristics with rheumatoid arthritis (RA), and new, rationally designed drugs that are effective in RA also are proving active in PsA. Two such drugs, etanercept and infliximab, target tumor necrosis factor (TNF), a key component of the inflammatory response. This review discusses the rationale for and experience with the use of these agents in PsA. Etanercept is a dimeric fusion protein that binds specifically to TNF, blocking its interaction with cell surface TNF receptors. Infliximab is a chimeric (murine/human) monoclonal antibody that binds to TNF and inhibits its binding to its receptor. A randomized placebo‐controlled trial of etanercept in PsA found statistically significant benefits for this agent in measures of arthritic activity and psoriatic severity. There have been anecdotal reports of the efficacy of infliximab in PsA, but results from controlled clinical trials of this agent in PsA have not been reported. TNF inhibitors represent new therapeutic options for patients with PsA. The potential advantages of treatment with etanercept and infliximab early in the disease course are discussed.

On the phenotypic spectrum of serine biosynthesis defects.

L-serine is a non-essential amino acid that is de novo synthesized via the enzymes phosphoglycerate dehydrogenase (PGDH), phosphoserine aminotransferase (PSAT), and phosphoserine phosphatase (PSP). Besides its role in protein synthesis, L-serine is a precursor of a number of important compounds. Serine biosynthesis defects result from deficiencies in PGDH, PSAT, or PSP and have a broad phenotypic spectrum ranging from Neu-Laxova syndrome, a lethal multiple congenital anomaly disease at the severe end to a childhood disease with intellectual disability at the mild end, with infantile growth deficiency, and severe neurological manifestations as an intermediate phenotype. In this report, we present three subjects with serine biosynthesis effects. The first was a stillbirth with Neu-Laxova syndrome and a homozygous mutation in PHGDH. The second was a neonate with growth deficiency, microcephaly, ichthyotic skin lesions, seizures, contractures, hypertonia, distinctive facial features, and a homozygous mutation in PSAT1. The third subject was an infant with growth deficiency, microcephaly, ichthyotic skin lesions, anemia, hypertonia, distinctive facial features, low serine and glycine in plasma and CSF, and a novel homozygous mutation in PHGDH gene. Herein, we also review previous reports of serine biosynthesis defects and mutations in the PHGDH, PSAT1, and PSPH genes, discuss the variability in the phenotypes associated with serine biosynthesis defects, and elaborate on the vital roles of serine and the potential consequences of its deficiency.

Synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome treated with a combination of isotretinoin and pamidronate.

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a clinically heterogeneous entity, encompassing a variety of debilitating conditions that have in common inflammation of the skeletal system and skin. To date, there is a paucity of documented efficacious treatment options. We report a 48-year-old man with skeletal and cutaneous signs and symptoms who improved dramatically after treatment with a combination of isotretinoin and pamidronate. This report provides an alternative treatment regimen for SAPHO that addresses the possible underlying pathophysiology of this likely underdiagnosed syndrome.

A randomized, prospective, blinded, split-face, single-center study comparing polycaprolactone to hyaluronic acid for treatment of nasolabial folds

Dermal fillers have continuingly been under development to increase safety, efficacy, and longevity. Biostimulatory dermal fillers, such as calcium hydroxylapatite fillers, have already been shown to be superior in efficacy compared to nonanimal stabilized hyaluronic acid (NASHA)‐based fillers.

Fenestration of auricular cartilage to expedite secondary intention healing

After removal of skin lesions including carcinomas, surgery of the external ear repair provides a challenge to the surgeon anatomically and physiologically. The auricular cartilage has minimal vascularity and creates a convoluted physical conformation. Primary closures and grafts performed on surgical ear defects are difficult to design and execute. Fenestration of the auricular cartilage creates a rich vascular bed that aids in healing by secondary intention or graft uptake. The present article illustrates how to perform the above‐mentioned surgical technique.

Topical Corticosteroid Use in the Middle East

The use of topical steroids in the Middle East is quite common as the regulations of dispensing to patients are lax. Even though the uses of these medications are limited in the pediatric population in fear of their possible side effects, their use in adults is mainly in the treatment of pigmentary disorders. Given that such conditions are common, abuse is highly possible. The occurrence of adverse events, such as atrophy, is common in this population group.

Actinic keratosis - review for clinical practice

Actinic keratosis (AK) is a lesion that arises as a result of excessive exposure to solar radiation and appearing predominantly on Fitzpatrick phototype I and II skin. Given that some AKs evolve into squamous cell carcinoma, these lesions are considered premalignant in nature, occurring mostly in elderly men and immunosuppressed individuals chronically exposed to ultraviolet (UV) radiation. There are several mechanisms for the formation of AKs; among them are oxidative stress, immunosuppression, inflammation, altered proliferation and dysregulation of cell growth, impaired apoptosis, mutagenesis, and human papillomavirus (HPV). Through the understanding of these mechanisms, several treatments have emerged. Among the options for AK treatment, the most commonly used include 5‐fluorouracil (5‐FU), cryotherapy, diclofenac, photodynamic therapy (PDT), imiquimod (IQ), retinoids, and ingenol mebutate (IM). There have been recent advances in the treatment options that have seen the emergent use of newer agents such as resiquimod, betulinic acid, piroxicam, and dobesilate. The combination between therapies has presented relevant results with intention to reduce duration of therapy and side effects. All AK cases must be treated because of their propensity to transform into malignancy and further complicate treatment. In addition to medical or surgical care, education about sun exposure prevention remains the best and most cost‐effective method for AK prevention. The objective of this article is to conduct a literature review of the clinical presentation of AK including advances in treatment options available.

Tanning practice, perception, and sunburn among Emirati youth

Ultraviolet (UV) rays from the sun is considered the most prevalent, preventable carcinogen in humans. Over the past decades, the incidence of sun-related skin cancer has increased. The UAE has a hot desert climate with high humidity, low rainfall, and sunny days most of the year. Sun exposure in the United Arab Emirates (UAE) is among the highest in the world. Although UV exposure is important to protect against bone disease, such as rickets, osteomalacia, and osteoporosis, as it plays a role in vitamin D synthesis. It is also used by dermatologists to treat several dermatological conditions such as psoriasis and vitiligo. However, chronic unnecessary sun exposure to normal skin can increase the risk of sun-related skin cancer. Perception that a suntan makes one more attractive and/or healthier may reinforce sun tanning and contribute to excessive sun exposure. It has been shown that perception regarding the attractiveness of a tan is strongly correlated with sun tanning. A study by Richard et al. showed that the number of large nevi at the end of the second decade is influenced by cumulative sun exposure, as traumatizing sun exposure makes small nevi grow. Modifying the tanning perception among a population at risk may play an important role in behavioral changes that could help reduce skin cancer risk. Public health campaigns began at the national level first in Australia, and nowadays in different countries in Europe and the United States, to increase public awareness regarding risks associated with excessive UV exposure and to encourage sun protective behavior. A study by Montague et al. showed that the percentage of people who liked to get a suntan dropped from 61% in 1988 to 35% in 1998 as a result of such campaigns. The prevalence of sun tanning in the Middle East is presumed to be extremely low as a result of cultural and religious aspects. Exposing the body to sun in public or mixed places is not common practice among the local population; in addition, the traditional dress covers almost all of the body and minimizes sun exposure. Perception of beauty is associated with lightening the skin, rather then tanning it, as shown in a study of Jordanian females, in which 60.7% reported the use of skin-lightening products. In this area, data are lacking regarding tanning perception and incidence of sunburns. A sample of UAE university students was surveyed to understand tanning perception, prevalence, and practice among this age group, to gain insight into the cultural effect of tanning, and to gather information regarding the incidence of sunburns.